We look to you, as medical students nearing graduation, to help transform the quality and value of medical care. Your choice in a residency program will shape your care for patients for years to come and can also present opportunities to lead improvements in health care. Surely, this is one of the most important decisions you will make in your career.

Residency program reputation, location, and training curriculum are obviously major factors in your ranking of programs. It is also important to know that each teaching hospital has its own style and culture of practice that represents a hidden training curriculum. This Dartmouth Atlas report will help you understand these less visible hospital characteristics that can have profound effects on how you care for patients.

The report first provides background on health care variation and then presents information about specific teaching hospitals. (Information for nearly all teaching hospitals can also be found at this web site.) When you read the report, we would encourage you to consider the current problems and future opportunities in health care, and how your training can help you become a leader in tomorrow's health care system.

With very best wishes to our future physicians,

Wiley "Chip" Souba, MD, ScD, MBA
Vice-President for Health Affairs at Dartmouth College and Dean of the Geisel School of Medicine at Dartmouth

John E. Wennberg, MD, MPH
Founder and Director Emeritus of the Dartmouth Institute for Health Policy and Clinical Practice

David C. Goodman, MD, MS
Director of the Center for Health Policy Research, The Dartmouth Institute for Health Policy and Clinical Practice

This report, supported by The John A. Hartford Foundation, explores the care experienced by older adults in the U.S., including the number and types of care providers they see, along with the frequency with which they have contact with the health care system. It identifies areas where improvements are most needed and recognizes areas in which improvements are already under way. Finally, it notes the distinctive challenges and opportunities presented by people with multiple chronic conditions and dementia. Read the report, policy-oriented or consumer-oriented press release, download data tables, or purchase a copy.

A casual reader of The New York Times article by Kevin Quealy and Margot Sanger-Katz, "The Experts Were Wrong about the Best Places for Better and Cheaper Health Care," would be forgiven if they missed this critical point. By focusing only on total spending—price times quantity—they give the impression that Medicare data tells us nothing about private insurance markets. Not so.

The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health
Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation,
including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.